AB1500 TNF INHIBITORS ARE SAFE AND EFFECTIVE IN PATIENTS WITH SEVERE BEHÇET’S DISEASE: DATA FROM EASTERN TURKEY, INTERSECTION OF THE SILK ROAD
Authors: M. Bektaş, E. Oguz, M. Özer
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Behçet's disease(BD) is a chronic inflammatory multi-systemic disease that affect skin-mucosa, joints, eye and blood vessels. Biological disease modifying anti-rheumatic drug(b-DMARD) treatment is an emerging option into the management of severe BD. <h3>Objectives</h3> We aimed to evaluate the clinical features and associated factors of outcome in patients with BD receiving b-DMARD treatment. <h3>Methods</h3> This retrospective observational study was carried out in a tertiary referral center in Van province, Eastern of Turkey.Remission was defined as no exacerbation and/or new development of clinical manifetations attributed BD at least three months.Active disease and/or relapse was defined as inadequate response to conventional treatment and/or new development of organ or system manifestations under the treatment.Ongoing mucocutaneus manifestations did not consider as active disease or relapse. <h3>Results</h3> We included 80 BD patients(76.3% male) who received b-DMARD therapy into the study. Mean±standard deviation(SD) of the patients was 33.3±8.8 years and median(interquartile range [IQR]) disease duration was 10(12) years.Among those patients, recurrent oral ulcer was in 98.5%, genital ulcer in 71.3%, pseudofolliculitis in 80%, erythema nodosum-like nodular lesions in 67.5%, superficial thrombophlebitis in 37.5%, uveitis in 53.8%, pathergy positivity in 66%, arthritis in 46.3%, spondylitis in 9%, gastrointestinal(GIS) involvement in 7.5%, parenchymal central nervous system(CNS) in 11.3%, parenchymal lung in 3.8%, vascular in 44%. While 28 patients(35%) had venous and 7 patients(8.8%) had arterial involvement. Overall, nearly all patients received colchicine(98.8%) and azatiopyrine (98.8%) as a background therapy, cyclophosphamide was used in 11.3%, cyclosporin in 22.5%, mycophenolate in 3.8% and interferon in 30%.Infliximab(IFX) and adalimumab(ADA) were initiated in 54(67.5%) and 26(32.5%) patients, respectively.Overall and first line retention rate were 84.7% and 92.6% for IFX and 83.3% and 80.8% for ADA, respectively(table 1).IFX was stopped in 9 patients which were in 2 patients due to allergic reaction and tuberculosis, 3 patients for inefficacy, one patient for heart failure and one patient for orbital zona.Although, no serious advers event was observed with ADA, 5 patients were switched to IFX for inefficacy.While during the follow-up, lung lobectomy were needed in one patients, no death was observed.Overall, 72 patients(90%) resumed b-DMARD end of the study;b-DMARD was stopped in 3 patients(3.8%) due to severe advers events and in 5 patients(6.2%) prolonged remission. All those patients were retained in remission after b-DMARD cessation. GIS involvement was negatively associated with b-DMARD retention in univariate(4.2% vs 33.3%;p=0.017,OR:9.8) and multivariate analysis(p=0.01,OR: 0.09,95 % confidence interval [CI]: 0.014-0.575).Higher disease duration(p=0.007,OR:5.8,95 %CI:1.6-20.8), superficial thrombophlebitis (p=0.018,OR:1.14,95%CI:1.024-1.28) were associated with corticosteroid withdrawal in multivariate analysis. <h3>Conclusion</h3> During the follow-up, no case of death was observed among b-DMARD receiving BD patients.Most patients were in remission, steroid-off and also retained on b-DMARD treatment.Biological treatment was safe and effective in patients with severe Behçet's disease. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.